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Regulations and Curriculafor

Post Graduate Degree and Diploma Coursesin

Medical Sciences

2000

Volume III: Clinical Subjects

M. Ch. in Plastic and Reconstructive Surgery

Rajiv Gandhi University of Health Sciences, Karnataka4th 'T' Block, Jayanagar, Bangalore - 560 041

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Rajiv Gandhi University of Health Sciences, Karnataka4th T Block, Jayanagar, Bangalore - 560 041

No. UA/ORD-06/1999-2000 01.01.2000

NOTIFICATION

Sub: Revised Ordinances pertaining to Post Graduate Degree, Diploma and Super Speciality Courses in Medicine

Ref: Minutes of the 16th syndicate meeting held on 16.11.1999.

In exercise of the powers conferred under Sec. 35(2) of the RGUHS Act, the Syndicate at its meeting held on 16.11.1999 has been pleased to approve the Revised Ordinances pertaining to Post Graduate Degree, Diploma and Super Speciality Courses in Medicine as given in schedule here to annexed.

The Revised Ordinances as above shall come into force immediately and is applicable for University examination of March 2000 and onwards.

By order, Sd/REGISTRAR

To

1. The Principals of all Medical Colleges affiliated to RGUHS2. The Members of the Syndicate/Senate/Academic Council.


Regulations for Post Graduate Degree and Diploma Courses in Medical Sciences(Annexure to University Notification No. UA/ORD-6/99-2000 dated 01.01.2000)

Contents

Chapter No. PageNotificaton 3

Chapter I Regulations 4

Chapter II Goals & Objectives 12

Chapter III Course Description


14

Chapter IV Monitoring Learning Progress 30

Chapter V Medical Ethics 41


Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

Regulations for Post Graduate Degree and Diploma Courses in Medical Sciences

Chapter I

1. Branches of Study

1.1 Postgraduate Degree Courses

The following courses of studies may be pursued.A. M.D. (Doctor of Medicine)

1. Anaesthesiology2. Aviation Medicine3. Anatomy4. Biochemistry5. Community Medicine6. Dermatology, Venereology and Leprosy7. Forensic Medicine8. General Medicine9. Microbiology10. Pathology11. Paediatrics12. Pharmacology13. Physiology14. Psychiatry15. Radio-diagnosis16. Radio-threrapy17. Tuberculosis & Respiratory Medicine

and such other subjects as might have been introduced by the Universities in Karnataka prior to commencement of Health University i.e., 1.6.1996, or recognised by Medical Council of India.

B. M.S. (Master of Surgery)

1. General Surgery2. Obstetrics and Gynecology 3. Ophthalmology4. Orthopedics5. Oto-Rhino-Laryngology

and such other subjects as might have been introduced by the Universities in Karnataka prior to commencement of Health University i.e., 1.6.1996, or recognised by Medical Council of India.

C. D.M. (Doctor of Medicine)1. Cardiology and such subjects recognised by Medical Council of India.


D. M.Ch (Master of Chirurgie)M. Ch. in Plastic and Reconstructive Surgery

1.2 Postgraduate Diploma Courses Post graduate diploma course may be pursued in the following subjects:

Child Health (D.C.H.), Obstetrics and Gynaecology (D.G.O.), Otorhinolaryngology (D.L.O.), Ophthalmology (D.O.), Orthopaedics (D.Ortho), Anaesthesiology (D.A.), Clinical Pathology (D.C.P.), Microbiology (D. Micro), Public Health (D.P.H), Forensic Medicine (D.F.M.), Dermatology, Venerology and Leprosy (D.D.V.L.), Psychiatry (D.P.M.), Radio-Diagnosis (DMRD), Radio-therapy (DMRT), Tuberculosis and Chest Diseases (D.T.C.D.) and such other subjects as might have been introduced by the Universities in Karnataka prior to commencement of Health University i.e., 1-6-1996, and recognised by Medical Council of India.

2. Eligibility for Admission

2.1 MD / MS Degree and Diploma Courses: A candidate affiliated to this university and who has passed final year M.B.B.S. examination after pursuing a study in a medical college recognised by the Medical Council of India, from a recognised Medical College affiliated to any other University recognised as equivalent thereto, and has completed one year compulsory rotating internship in a teaching Institution or other Institution recognised by the Medical Council of India, and has obtained permanent registration of any State Medical Council shall be eligible for admission.

2.2 D.M and M.Ch Courses

D.M.: Candidate seeking admission for D.M courses in any subject must posses recognised degree of MD (or its equivalent recognised degree) in the subject specified in the regulations of the Medical Council of India from time to time.

M.Ch : Candidate seeking admission for M.Ch course in any subject must posses recognised degree of MS (or its equivalent recognised degree) in the subject specified in the regulations of the Medical Council of India from time to time.

3. Obtaining Eligibility Certificate by the University before making Admission

No candidate shall be admitted for any postgraduate degree/diploma course unless the candidate has obtained and produced the eligibility certificate issued by the University. The candidate has to make an application to the University with the following documents along with the prescribed fee :

1 MBBS and MS pass / degree certificate issued by the University.2 Marks cards of all the university examinations passed MBBS course.3 Attempt Certificate issued by the Principal.4 Certificate regarding the recognition of the medical college by the Medical Council of

India.5 Completion of internship certificate.6 In case internship was done in a non-teaching hospital, a certificate from the Medical

Council of India that the hospital has been recognised for internship.

7 Registration by any State Medical Council and 8 Proof of SC/ ST or Category I, as the case may be.


Candidates should obtain the Eligibility Certificate before the last date for admission as notified by the University.

A candidate who has been admitted to postgraduate course should register his / her name in the University within a month of admission after paying the registration fee.

4. Intake of Students: The intake of students to each course shall be in accordance with the ordinance in this behalf.

5. Duration of Study

a) M.D /M.S Degree CoursesThe course of study shall be for a period of 3 years consisting of 6 terms.

b) D.M /M.ChThe courses of study shall be for a period of 3 years consisting of 6 terms.

c) Diploma courses:The course of study shall be for a period of 2 years consisting of 4 terms.

5.2 Requirement to complete the course -- deleted *

6. Method of training

The training of postgraduate for degree/diploma shall be residency pattern with graded responsibilities in the management and treatment of patients entrusted to his/her care. The participation of the students in all facets of educational process is essential. Every candidate should take part in seminars, group discussions, grand rounds, case demonstration, clinics, journal review meetings, CPC and clinical meetings. Every candidate should be required to participate in the teaching and training programme of undergraduate students. Training should include involvement in laboratory and experimental work, and research studies. Basic medical sciences students should be posted to allied and relevant clinical departments or institutions. Similarly, clinical subjects' students should be posted to basic medical sciences and allied speciality departments or institutions.

7. Attendance, Progress and Conduct

7.1 A candidate pursuing degree/diploma course should work in the concerned department of the institution for the full period as a full time student. No candidate is permitted to run a clinic/laboratory/nursing home while studying postgraduate course.

7.2 Each year shall be taken as a unit for the purpose of calculating attendance.

7.3 Every student shall attend symposia, seminars, conferences, journal review meetings,

grand rounds, CPC, case presentation, clinics and lectures during each year as prescribed by the department and not absent himself / herself from work without valid reasons.

---------------------------------------------------------------------------------------------------------------------* deleted vide university notification No. UA/ORD-6/1999-2000 dated 9.4.2001


7.4 Every candidate is required to attend a minimum of 80% of the training during each academic year of the post graduate course. Provided further, leave of any kind shall not be counted as part of academic term without prejudice to minimum 80% attendance of training period every year.

7.5 Any student who fails to complete the course in the manner stated above shall not be permitted to appear for the University Examinations.

8. Monitoring Progress of Studies

8.1 Work diary / Log Book - Every candidate shall maintain a work diary and record of his/her participation in the training programmes conducted by the department such as journal reviews, seminars, etc. (please see Chapter IV for model checklists and logbook specimen copy). Special mention may be made of the presentations by the candidate as well as details of clinical or laboratory procedures, if any conducted by the candidate. The work diary shall be scrutinised and certified by the Head of the Department and Head of the Institution, and presented in the university practical/clinical examination.

8.2 Periodic tests:

Incase of degree courses of three years duration (MD/MS, DM, MCh.), the concerned departments may conduct three tests, two of them be annual tests, one at the end of first year and the other in the second year. The third test may be held three months before the final examination. The tests may include written papers, practicals / clinicals and viva voce. Records and marks obtained in such tests will be maintained by the Head of the Department and sent to the University, when called for.

In case of diploma courses of two years duration, the concerned departments may conduct two tests, one of them be at the end of first year and the other in the second year three months before the final examination. The tests may include written papers, practicals / clinicals and viva voce.

8.3 Records: Records and marks obtained in tests will be maintained by the Head of the Department and will be made available to the University or MCI.

9. Dissertation

9.1 Every candidate pursuing MD/MS degree course is required to carry out work on a selected research project under the guidance of a recognised post graduate teacher. The results of such a work shall be submitted in the form of a dissertation.

9.2 The dissertation is aimed to train a post graduate student in research methods and techniques. It includes identification of a problem, formulation of a hypothesis, search and review of literature, getting acquainted with recent advances, designing of a research study, collection of data, critical analysis, comparison of results and drawing conclusions.

9.3 Every candidate shall submit to the Registrar (Academic) of the University in the prescribed proforma, a synopsis containing particulars of proposed dissertation work within six months from the date of commencement of the course on or before the dates notified by the University. The synopsis shall be sent through the proper channel.


9.4 Such synopsis will be reviewed and the dissertation topic will be registered by the University. No change in the dissertation topic or guide shall be made without prior approval of the University.

9.5 The dissertation should be written under the following headings:

i. Introductionii. Aims or Objectives of studyiii. Review of Literatureiv Material and Methodsv. Resultsvi. Discussionvii. Conclusionviii. Summaryix Referencesx. Tablesxi. Annexures

9.6 The written text of dissertation shall be not less than 50 pages and shall not exceed 150 pages excluding references, tables, questionnaires and other annexures. It should be neatly typed in double line spacing on one side of paper (A4 size, 8.27" x 11.69") and bound properly. Spiral binding should be avoided. The dissertation shall be certified by the guide, head of the department and head of the Institution.

9.7 Four copies of dissertation thus prepared shall be submitted to the Registrar (Evaluation), six months before final examination on or before the dates notified by the University.

9.8 The dissertation shall be valued by examiners appointed by the University. Approval of dissertation work is an essential precondition for a candidate to appear in the University examination.

9.9 Guide: The academic qualification and teaching experience required for recognition by this University as a guide for dissertation work is as per Medical Council of India Minimum Qualifications for Teachers in Medical Institutions Regulations, 1998. Teachers in a medical college/institution having a total of eight years teaching experience out of which at least five years teaching experience as Lecturer or Assistant Professor gained after obtaining post graduate degree shall be recognised as post graduate teachers.

A Co-guide may be included provided the work requires substantial contribution from a sister department or from another medical institution recognised for teaching/training by Rajiv Gandhi University of Health Sciences/Medical Council of India. The co-guide shall be a recognised post graduate teacher of Rajiv Gandhi University of Health Sciences. 9.10 Change of guide: In the event of a registered guide leaving the college for any reason or in the event of death of guide, guide may be changed with prior permission from the university.


10. Schedule of Examination

The examination for M.D / M.S courses shall be held at the end of three academic years ( six academic terms). The examination for D.M and M.Ch courses shall be held at the end of three years. The examination for the diploma courses shall be held at the end of two academic years (four academic terms). The university shall conduct two examinations in a year at an interval of four to six months between the two examination. Not more than two examinations shall be conducted in an academic year.

11. Scheme of Examination

11.1 M.D. / M.S. Degree

M.D. / M.S. Degree examinations in any subject shall consist of dissertation, written paper (Theory), Practical/Clinical and Viva voce.

11.1.1 Dissertation: Every candidate shall carryout work and submit a dissertation as indicated in Sl.No.9. Acceptance of dissertation shall be a precondition for the candidate to appear for the final examination.

11.1.2 Written Examination (Theory): A written examination shall consist of four question papers, each of three hours duration. Each paper shall carry 100 marks. Out of the four papers, the 1st paper in clinical subjects will be on applied aspects of basic medical sciences. Recent advances may be asked in any or all the papers.

11.1.3 Practical / Clinical Examination: In case of practical examination, it should be aimed at assessing competence and

skills of techniques and procedures as well as testing students ability to make relevant and valid observations, interpretations and inference of laboratory or experimental work relating to his/her subject.

In case of clinical examination, it should aim at examining clinical skills and competence of candidates for undertaking independent work as a specialist. Each candidate should examine atleast one long case and two short cases.

The total marks for practical / clinical examination shall be 200.

11.1.4 Viva Voce: Viva Voce Examination shall aim at assessing depth of knowledge, logical reasoning, confidence and oral communication skills. The total marks shall be 100 and the distribution of marks shall be as under:

(i) For examination of all components of syllabus 80 Marks (ii) For Pedagogy 20 Marks

11.1.5 Examiners: There shall be atleast four examiners in each subject. Out of them two shall be external examiners and two shall be internal examiners. The qualification and teaching experience for appointment as an examiner shall be as laid down by the Medical Council of India.


11.1.6 Criteria for declaring as pass in University Examination: A candidate shall secure not less than 50% marks in each head of passing which shall include (1) Theory, (2) Practical including clinical and viva voce examination.

A candidate securing less than 50% of marks as described above shall be declared to have failed in the examination. Failed candidate may appear in any subsequent examination upon payment of fresh fee to the Registrar (Evaluation).

11.1.7 Declaration of distinction: A successful candidate passing the University examination in first attempt will be declared to have passed the examination with distinction, if the grand total aggregate marks is 75 percent and above. Distinction will not be awarded for candidates passing the examination in more than one attempt.

11.2 D.M / M.Ch:

The examination shall consist of theory, clinical/practical and viva voce examination.

11.2.1 (Theory) (Written Examination): The theory examination shall consist of four question papers, each of three hours duration. Each paper shall carry 100 marks. Out of the four papers, the first paper will be on basic medical sciences. Recent advances may be asked in any or all the papers.

11.2.2 Practical / Clinical Examination: In case of practical examination it should be aimed at assessing competence, skills

of techniques and procedures as well as testing students ability to make relevant and valid observations, interpretence and experimental work relevant to his / her subject.

In case of clinical examination it should aim at examining clinical skills and competence of candidates for undertaking independent work as a specialist. Each candidate should examine atleast one long case and two short cases.

The maximum marks for Practical / Clinical shall be 200.

11.2.3 Viva Voce: Viva Voce examination shall aim at assessing thoroughly depth of knowledge, logical reasoning, confidence and oral communication skills. The maximum marks shall be 100.

11.2.4 Examiners: There shall be atleast four examiners in each subject. Out of them, two shall be external examiners and two shall be internal examiners. The qualification and teaching experience for appointment as an examiner shall be as laid down by the Medical Council of India.

11.2.5 Criteria for declaring as pass in University Examination: A candidate shall secure not less than 50% marks in each head of passing which shall include (1) Theory, (2) Practical including clinical and viva voce examination.



11.3 Diploma Examination:

Diploma examination in any subject shall consist of theory (written papers), Practical / Clinical and Viva - Voce.

11.3.1 Theory: There shall be three written question papers each carrying 100 marks. Each paper will be of three hours duration. In clinical subjects one paper out of this shall be on basic medical sciences. In basic medical subjects and para clinical subjects, questions on applied clinical aspects should also be asked.

11.3.2 Practical / Clinical Examination: In case of practical examination it should be aimed at assessing competence, skills

related to laboratory procedures as well as testing students ability to make relevant and valid observations, interpretation of laboratory or experimental work relevant to his/her subject.

In case of clinical examination, it should aim at examining clinical skills and competence of candidates for undertaking independent work as a specialist. Each candidate should examine atleast one long case and two short cases.

The maximum marks for practical / Clinical shall be 150.

11.3.3 Viva Voce Examination: Viva Voce examination should aim at assessing depth of knowledge, logical reasoning, confidence and oral communication skills. The total marks shall be 50.

11.3.4 Criteria for Pass: Criteria for declaring as pass in University Examination: A candidate shall secure not less than 50% marks in each head of passing which shall include (1) Theory, (2) Practical including clinical and viva voce examination.


11. 3.5 Declaration of distinction: A successful candidate passing the University examination in first attempt will be declared to have passed the examination with distinction, if the grand total aggregate marks is 75 percent and above. Distinction will not be awarded for candidates passing the examination in more than one attempt.

11.3.6 Examiners: There shall be atleast four examiners in each subject. Out of them, two shall be external examiners and two shall be internal examiners. The qualification and teaching experience for appointment as an examiner shall be as laid down by the Medical Council of India.

12. Number of Candidates per day. The maximum number of candidates for practical/clinical and viva-voce examination shall be as under:

MD / MS Course: Maximum of 6 per day Diploma Course: Maximum of 8 per day DM / M.Ch Course: Maximum of 3 per day


Chapter II

GOALS AND GENERAL OBJECTIVES OF POSTGRADUATE MEDICAL EDUCATION PROGRAM

GOAL

The goal of postgraduate medical education shall be to produce competent specialist and /or Medical teacher:

(i) who shall recognise the health needs of the community, and carry out professional obligations ethically and in keeping with the objectives of the national health policy;

(ii) who shall have mastered most of the competencies, pertaining to the specialty, that are required to be practiced at the secondary and the tertiary levels of the health care delivery system;

(iii) who shall be aware of the contemporary advances and developments in the discipline concerned;

(iv) who shall have acquired a spirit of scientific inquiry and is oriented to the principles of research methodology and epidemiology; and

(v) who shall have acquired the basic skills in teaching of the medical and paramedical professionals.

GENERAL OBJECTIVES

At the end of the postgraduate training in the discipline concerned the student shall be able to:

i) Recognise the importance of the concerned specialty in the context of the health need of the community and the national priorities in the health sector.

ii) Practice the specialty concerned ethically and in step with the principles of primary health care.

iii) Demonstrate sufficient understanding of the basic sciences relevant to the concerned specialty.

iv) Identify social, economic, environmental, biological and emotional determinants of health in a given case, and take them into account while planning therapeutic, rehabilitative, preventive and promotive measures/strategies.

v) Diagnose and manage majority of the conditions in the specialty concerned on the basis of clinical assessment, and appropriately selected and conducted investigations.

vi) Plan and advise measures for the prevention and rehabilitation of patients suffering from disease and disability related to the specialty.


vii) Demonstrate skills in documentation of individual case details as well as morbidity and mortality data relevant to the assigned situation.

viii) Demonstrate empty and humane approach towards patients and their families and exhibit interpersonal behaviour in accordance with the societal norms and expectations.

ix) Play the assigned role in the implementation of national health programmes, effectively and responsibly.

x) Organise and supervise the chosen/assigned health care services demonstrating adequate managerial skills in the clinic/hospital or the field situation.

xi) Develop skills as a self-directed learner, recognise continuing educational needs; select and use appropriate learning resources.

xii) Demonstrate competence in basic concepts of research methodology and epidemiology, and be able to critically analyse relevant published research literature.

xiii) Develop skills in using educational methods and techniques as applicable to the teaching of medical/nursing students, general physicians and paramedical health workers.

xiv) Function as an effective leader of a health team engaged in health care, research or training.

STATEMENT OF THE COMPETENCIES

Keeping in view the general objectives of postgraduate training, each discipline shall aim at development of specific competencies, which shall be defined and spelt out in clear terms. Each department shall produce a statement and bring it to the notice of the trainees in the beginning of the programme so that he or she can direct the efforts towards the attainment of these competencies.

COMPONENTS OF THE PG CURRICULUM

The major components of the PG curriculum shall be:

- Theoretical knowledge- Practical/clinical Skills- Training in Thesis (Not applicable to DM and M.Ch. courses)- Attitudes, including communication.- Training in research methodology.

Source: Medical Council of India, Regulations on postgraduate medical education, 1997.


Annexure to University Notification No: No. UA/ORD-06/1999-2000, dated, 01.01.2000

Chapter III


Course Contents

GoalsGoal of postgraduate course in Plastic and Reconstructive Surgery would be to train a surgeon with postgraduate qualification such as M.S. to:

Practice Plastic and Reconstructive Surgery efficiently and effectively backed by scientific knowledge and skill base.

Show empathy and caring attitude and maintain high ethical standards.

Evince keen interest in continuing surgical education; irrespective of whether working in a teaching institution or is a practicing plastic surgeon.

Be a motivated teacher – defined as Plastic Surgeon keen to share knowledge and skill with colleagues, juniors or any learner.

Objectives The objectives are laid out to achieve the goals of the course. These objectives are to be achieved by the time the candidates complete the course. The objectives may be considered under the following subheading.

1. Knowledge 2. Skills 3. Human values, Ethical practice and Communication abilities

At the end of the training, the candidate must be able to:

Knowledge: Describe aetiology, pathophysiology, principles of diagnosis and management of

common plastic surgical problems including emergencies, in adults and children. Describe indications and methods for fluid and electrolyte replacement therapy including

blood transfusion. Describe common malignancies in the country and their management including

prevention. Demonstrate understanding of basic sciences relevant to plastic surgery. Identify social, economic, environmental and emotional determinants in a given case, and

take them into account for planning therapeutic measures. Recognize conditions that may be outside the area of his/her specialty/competence and

refer to appropriate specialist. Update himself by self-study and by attending courses, conferences and seminars relevant

to Plastic Surgery.


Teach and guide his team, colleagues and other students.

Undertake audit, use information technology tools, and carry out research, both basic and clinical, with the aim of publishing his work and presenting his work at various scientific forum.

Skills Take a proper clinical history, examine the patient, perform essential diagnostic

procedures and order relevant tests and interpret them to come to a reasonable diagnosis about the surgical conditions.

Perform common plastic surgical operations independently and the major procedures with the help of a senior surgeon.

Provide basic and advance life support services (BLS & ALS) in emergency situations. Manage acute cranio- facio -maxillary surgery, burns, and hand injury. Undertake thorough wound management, including burns wounds, aesthetic surgery. Do complete patient monitoring including the preoperative and postoperative care of

patient. Advise regarding the operative or non-operative management of the case and carry out

this management effectively.

Human Values, Ethical Practice And Communication abilities: Adopt ethical principles in all aspects of his surgical practice, Professional, honesty and

integrity are to be fostered. Surgical care is to be delivered irrespective of the social status, caste, creed or religion of the patient.

Develop communication skills, in particular, the skill to explain. Various options available in management and to obtain a true informed consent from the patient.

Provide leadership and get the best out of his team in a congenital working atmosphere. Apply high moral and ethical standards while carrying out human or animal research. Be humble and accept the limitation in his knowledge and skills and to ask for help from

colleagues when needed. Respect patient’s rights and privileges including right to information and right to seek a

second opinion.

Essential KnowledgeA list of objectives related to knowledge and higher cognitive abilities that are expected to be achieved during the course is given. The course contents have been identified and categorized as essential knowledge as under. This is to enable the student to achieve the objectives of the course. A Plastic surgeon should also have knowledge of some common problems in allied specialties. Further he should be familiar with complications, current controversies and recent advances in these topics.

The topics are: Basic sciences and Plastic surgery topics

Basic Sciences These include anatomy, physiology, biochemistry, microbiology and pathology, as found in current text books. These standard topics are recommended to the studies in as much as they are applicable to the practice of plastic surgery. The stress is on anatomy of the parts dealt with by the plastic surgeon as defined by the skills list; pathophysiology and surgical pathology.


Plastic Surgery TopicsHistory of Plastic SurgeryClinical history and examination – detailed systematic history taking, clinical examination of various systems, coming to a provisional working diagnosisInformed consent / Medico Legal issues – understanding the implications of acts of omission and commission in practice. Issues regarding Consumer Protection Act – implications in a medico-legal case like accidents, assaults etc.Communication skills with patients – understanding clarity in communication, compassionate explanations and giving emotional support to at the time of suffering and bereavementPrinciples of Surgical audit – understanding journal based literature study; the value of text book, reference book articles; value of review articles; original articles and their critical assessment.Research Methodology & Biostaistics - understanding the value of retrospective, prospective, randomized controlled and blinded studies understanding the principles and meanings of various biostatistical tests applied in these studiesMedical Ethics/Social responsibilities of surgeonsUse of Computers in Plastic Surgery – Components of a Computer; its use in practice – principles of word processing, spreadsheet functions, database and presentation; the internet and its uses. The value of computer based systems in bio medical equipment value of computer in imaging and mock surgeryPreoperative workup – concept of fitness for surgery; principles of planning, basic medical workup; workup in special situations like, diabetics, renal failure, cardiac and respiratory illness; risk stratificationPrinciples of operative surgery like sepsis, asepsis, antisepsis, sterilization surgical sutures, drains prosthetic grafts. Hepatitis, AIDS.Postoperative care – concept recovery room are; airway management; assessment of wakefulness; management of cardiovascular instability in this period; criteria for shifting to a ward; pain management.Basic Plastic surgical instrumentation – Principles of surgical instrumentation; their maintenance and sterilizationSurgical diathermyPrinciples of Lasers and its use in plastic surgeryWound management – wound healing; factors influencing healing; basic surgical techniques; properties of suture materials; appropriate use of suturesManagement of keloids and hypertrophic scars.Fluid and electrolyte balance / Acid – Base balance - the body fluid compartments; Metabolism of water and electrolytes; factors maintaining homeostatsis; causes for and treatment of acidosis and alkalosis. Both in adult and children.Blood Transfusion – blood grouping; cross matching; blood component therapy; complications of blood transfusion; blood substitutes; auto transfusions; cell savers.Surgical infections sepsis and asepsis and antisepsis; microbiological principles; rational use of antibiotics; special infections like synergistic gangrene and diabetic foot infections. Hepatitis and AIDS. Septicaemia and its managementNutrition in health and disease – nutritional assessment; metabolic response to stress; need for nutritional support; enteral nutrition; routes of access to GI tract; parenteral nutrition; access to central veins for nutritional support.Principles of oncology - cell kinetics; causation of tumours; principles of oncologic surgery; radiotherapy and chemotherapy; paraneoplastic syndromes; cancer pain management; palliative care.Principles of Burn management – Types of thermal injury; assessment of extent; immediate


management; late management; skin cover; rehabilitation including post burns complications.Principles of fracture management – fracture healing; principles of immobilization; complications; principles of internal and external fixation; hand and maxillo-facial injuries including AO method.Genito Urinary SurgeryAirway obstruction / management – anatomy of the airway; principles of keeping the airway patent; mouth to mouth resuscitation; oropharyngeal airway; endotracheal intubation; circo-thyroidectomy; tracheostomy.Gynaecological surgeryVaginal agenesis; Gender dysphoriaShock and Pulmonary failure – types of shock; diagnosis; resuscitation; pharmacologic support; ARDS and its causes; prevention; ventilatory support.Anaesthesia – stages of anaesthesia; pharmacology of inhalation; intravenous and regional anaesthesia; muscle relaxants. Pediatric anaesthesia and problems related to that.Assessment of trauma – poly trauma patients, closed abdominal and chest injuries / penetrating injuries/head injury, urological injuries; trauma scores management of polytrauma cases including lower limb trauma.Critical care- Cardiorespiratory failure – management of shock; including monitoring; sepsis scores; pharmacological supports.Breast disease – physiology and breast anatomy; benign and malignant disease; diagnosis; investigation; screening for cancer; genetics of breast cancer; principles of reconstruction, soft tissue neoplasms. Reduction and augmentation mammoplasty. Gynaecomastia and its managementNeurosurgeryCranio-facial deformities including craniostenosis, complex craniofacial clefts & Skull Base Surgery, craniofacial injury management. Management of calvarial defects

Peripheral Nerve Injuries including anatomy and physiology of repair and regeneration. Brachial plexus injuryUndescended testisHypospadias/EpispadiasUrinary diversionInfertilityVasectomySurgery for impotenceImaging - principles, investigations, including CT/ MRI CT guided FNAB/CTumour - biology and management of including chemotherapy and adjuvant therapyBreast – benign & malignant conditionsChemotherapy / adjuvant therapyHead and neck tumours, pathology and its managementSkin tumours - including basal cell carcinoma, squamous cell carcinoma and melanoma, including oral cancer and tongue cancer.Salivary gland tumors including parotid tumours.Post tumor excision- surgical reconstructionPrincipals of radiotherapyCardio thoracic surgeryFlial chest, thoracic traumaAV malformations- aetiology, pathology, classification and its managementVaricose veins


Chronic venous insufficiencyVascular emergencies – trauma, embolismMicrovascular surgery – principles including /Free flap and replantation, Reanimation of face, functional muscle transferVascular imagingMeningo-mylelcoels,encephalocoelsSpinal fusion defects.Ventral defectsAno rectal anomalies.Implants – BiocompatibilityBiology including surgical implants, alloplastic metal and synthetic.Bone and cartilageHair transplantFace liftRhinoplastyLaser surgeryEndoscopy and minimally invasive surgery in plastic and reconstructive surgery.

Operative SkillsA list of operative procedures have been given in the following tables. It is also recommended that graded responsibility be given depending upon on the knowledge and the skills already acquired by the student. The year wise distribution of the skills recommended are to be used as a general guideline and some overlap is inevitable. List of skills in various specialty subjects has been made. These skills in specialty subjects may be acquired both during the specialty postings and in the parent department. The list within the tables, indicates the surgical procedures that the student should, by the end of the course, be able to perform independently (P) by himself/herself or should have performed with assistance (PA) during the course. The other categories of the surgical procedures that the student should either have observed (O) or have assisted the operating surgeon (A) are also mentioned. Note for all categories, the student washes up in the operating room.

Key for abbreviations usedO - ObserveA - Assist seniorPA - Performs with assistance from a senior or under supervisionP - Performs independently

Basic techniques of Plastic Surgery

Elliptical excision Multiple excision Wedge excision T excision Circular excision Cautery Electro Surgery Skin suturing techniques

A. interrupted,B. mattress,C. subdermal buried


List of Procedures indicating minimum number to be observed (O), Assisted (A), Performed under assistance (PA) and Performed independently (P) during the course, (year wise)

Skills I Year II Year III YearFLAPSLocal flaps-Advancement O –3, PA - 3 PA -3 P - 5

- Single O –2, PA - 2 PA –2 P – 4 - Bipedicle O - 3 PA -1 P - 1

- Transposition flap O - 3, PA - 2 PA – 2, P- 1 P - 3 - Rotation Flap interposition flap O –2, PA - 1 PA – 1, P- 1 P - 3Z Plasty O – 3, PA - 5 PA – 5, P- 3 P - 5V-Y Plasty O – 3, PA - 1 PA - 2 P - 2Rhemboid flap O – 5, PA - 3 PA - 4 P - 5Axial Flaps D.P. Flaps O - 3, PA - 3 PA – 3, P - 1 P - 5Fascio cutaneous flaps O – 2, PA - 1 PA - 2, P - 1 P - 2Septocutaneous flaps O – 2, PA - 2 PA - 2, P - 1 P - 2Musculocutaneous flaps O – 2, A - 2 O – 2, PA - 1 PA – 2, P - 2Muscle pedicle O – 2, A - 2 O – 2, PA - 1 PA – 2, P - 1Tissue transplantationAuto O- 3, PA - 3,

P - 2PA – 3, P - 5 P - 10

HomoXeno graftsImplants O – 2, PA -1 O – 2, PA - 1 PA - 2Metals O - 2 O – 2, PA - 2 PA – 2, P - 2Silicones O - 2 O - 2 O - 2Tissue expanders O - 2 O – 1,PA – 1 PA - 2Screws and plates O – 2, A - 2 O –2, A –2,

PA-1PA – 2, P - 2

Head and neckFacial hemiatrophy O - 2 O - 2 A - 2Hemi facial microsomia O -1 O - 1 O- 1Apert’s syndrome/ Treacher Collin’s Syndrome O –1 O - 1Complex facial cleft O - 2 A - 2Maxillofacial surgeryIntermaxillary wiring O – 2, A - 2 A – 2, PA - 1 PA – 2, P - 2Screw plate fixation O - 1, A - 1 A – 2,PA - 1 P - 2Blowout fracture treatment O - 1 O - 1 PA - 1Pan facial fractures treatment O - 2, A - 1 O - 1, PA - 1 PA – 1, P –1ScalpReconstruction - 1. SSG PA - 5 PA – 2, P - 5 P - 5 2. Local flaps PA – 2, PA – 2, P - 2 3. Tissue expanders O - 1 O – 1, A - 1 PA - 1Oculoplastic surgeryEyelid – traumatic loss – reconstruction / malignant excision - reconstruction

O - 1 O - 1 PA - 1

Facial paralysis – fascia lata sling/ any other reanimation

O - 1 O - 1 O - 1

Ptosis correction O - 1 O – 1, PA - 1 PA - 1


Blepheroplasty O - 1 O – 1 O - 1OtoplastyEar reconstruction –congenital –traumatic O - 1 O - 1 O - 1Head and neck tumorsOral malignancyComposite excision reconstruction O - 1 A - 2 A – 2, PA - 1 PA – 1, P - 1Jaw tumours – excision – reconstruction O - 1 O – 1, A - 1 PA - 1Radical Neck dissection O – 1, A - 1 O – 1, A – 2 A – 2, PA - 1Cosmetic surgeryChemical peel/Derma abrasion O - 1 O - 1 O - 1Face lift O - 1 O -1Laser O -1 O - 1 O -1Liposuction and body contouring O -1 O - 1 O -1Blepharoplasty O -1 O - 1 O -1Tangential excision O – 3, A - 3,

PA - 2A – 3, PA – 3 PA – 3, P - 3

IntegumentSSG O –5, A – 5,

P - 5P – 5 P - 5

Hairy naevous excision and SSG O – 1, A - 1 A – 1, PA - 1 P - 2Hypertrophic scar O – 4, PA- 4 PA – 4, P - 3 P - 5Keloids PA - 4 P – 4 P - 5Tattoos O– 1, PA - 1 PA –2, P- 1 P - 2HandFinger tip injuries O - 3, A - 2,

PA - 2PA – 2, P - 5 P - 5

Amputations O – 2, A - 3 PA – 2, P -3 P - 5InfectionsFractures and joint injuries of the hand O - 2 A – 2, PA - 2 P - 2Stiff finger jointsTendon injuries in forearm and hand-flexor-extensor

O – 2, A -2 A – 2, PA - 3 PA – 2, P - 3

Nerve injuries O - 1 A – 2, PA 1, A- 4Nerve graft O – 1 O – 1 O - 1Tumours of the hand – benign – malignant O - 2 O – 2, A - 2 A – 2, PA - 1

Microvascular surgeryFree flaps O - 2 O – 2, A - 1 A - 2Muscle flaps O - 1 O – 1, A - 1Skin flaps O - 2 O – 2, A - 1 A – 2, PA - 1Micro-neural repair O - 1 A - 1Replantation Microvascular Lab work O –3 O –4, A- 2 PA-2, P- 2RhinoplastyCosmetic surgery / Reduction / Augmentation O - 2 O – 2, A - 2 A – 3, PA - 2Corrective surgery O – 2 A – 2, PA - 1 A – 2, PA - 2Nose tip plasty O – 1 A – 1, PA - 1 PA – 1EarMicrotia O - 1 O – 1Lobule reconstruction / Repair O – 2, A - 2 A – 2, PA - 2 PA – 2, P – 4


Burn external ear reconstruction O - 1 O – 1, A - 1 A – 1, PA – 1Burn injuriesTangential excision O – 2, PA - 1 A – 4, PA - 2 PA – 4, P- 4TracheostomyEscharotomy – circumferential burns O – 3, A - 4 A – 2, PA - 2 P – 2Escharectomy O – 2, A - 4 A – 2, PA - 2 P – 4Skin grafting O - 2, A – 3 O – 2, A – 2,

PA - 2PA – 2, P – 5

Radiation injuries–coverage for such injuries O - 2 O - 2 A – 2Electrical burns O – 1, A - 2 O – 1, A – 2,

PA - 1PA – 2, P – 1

Amputations O - 1 O – 1, A - 1 PA – 1, P – 1Central line placement / Intubation O –1, PA - 1 O – 1, PA - 1 PA – 1, P - 1IntubationSKINTumours – benign – malignant O – 2, PA -2 A – 2, PA - 2 PA – 2, P – 3Premalignant conditions O - 2 O - 2 O – 2Lymphangioma O – 1, A - 1 O – 2, A - 1 O – 2, PA – 1Haemangioma O – 1, A - 1 O – 2, A - 1 O – 2, PA – 1Giant hairy pigmented naevi O – 1 O – 1 O- 1, PA-1Hypertrophic scar O - 3 O – 3, A - 3 A – 3, P – 3BREASTReduction O - 1 A - 1 A – 1Augmentation mammoplasty O - 1 A - 1 A – 1Breast reconstruction by flap O – 1, A - 1 A – 1, PA - 1 PA – 1Gynaecomacia O – 1, A - 1 A – 1, PA - 1 P – 1LOWER LIMBTrauma fractures with skin soft tissue loss O – 1, A - 1 A – 2, PA - 2 PA – 2, P - 3Flap cover, Infection / Non healing ulcer O-5, PA-2 PA –3, P –1 P - 4Lymphoedma surgery O - 1 O – 1, A - 1 A – 1, PA - 1PRESSURE SORESSSG O – 1 O – 1, A - 1 PA – 1Local flaps, faciocutaneous flaps O – 1, A - 1 A – 1, PA - 1 PA – 1, P - 1Neurovascular flaps O - 1 O - 1 O - 1Lipectomy O - 1 O - 1Liposuction O - 1 A - 1 A -1EXTERNAL GENITALIAHypospadias O - 1 O - 2 A - 2Epispadias O - 1 O - 1 A - 1Gender dysphoria O - 1Inter sex Vaginal agenesis O - 1 O – 1, A - 1 A – 1, PA - 1


Teaching and Learning Activities

A candidate pursuing the course should work in the institution as a full time student. No candidate should be permitted to run a clinic / laboratory / nursing home while studying postgraduate course. Each year should be taken as a unit for the purpose of calculating attendance.

Every student shall attend teaching and learning activities during each year as prescribed by the department and not absent himself/herself from work without valid reasons.

A list of teaching and learning activities designed to facilitate students acquire essential knowledge and skills outlined is given below. Depending on the facilities available, any or all of these methods may be employed.

1. Lectures : Lectures are to be kept to a minimum. They may, however, be employed for teaching certain topics. Lectures may be didactic or integrated.

a. Didactic lectures : Recommended for selected common topics for post graduate students of all specialties. Few topics are suggested as examples:

1) Bio-statistics2) Use of library3) Research Methods4) Medical code of conduct and medical ethics5) National health and disease control programmes6) Communication skills etc.

These topics may preferably taken up in the first few weeks of the 1st year.

b. Integrated Lectures : These are recommended to be taken by multidisciplinary teams for selected topics, eg. Jaundice, Diabetes mellitus, Thyroid etc.

2. Journal Club: Recommended to be held once a week. All the PG students are expected to attend and actively participate in discussion and enter in the Log Book relevant details. Further, every candidate must make a presentation from the allotted journal(s) of selected articles at least four times a year and a total of 12 presentations in three years. The presentations would be evaluated using check lists and would carry weightage for internal assessment. (See Checklist I of Internal Assessment). A time table with names of the student and the moderator should be announced at the beginning of every year.

3. Subject Seminar: Recommended to be held once a week. All the PG students are expected to attend and actively participate in discussion and enter in the Log Book relevant details. Further, every candidate must present on selected topics at least four times a year and a total of 12 seminar presentations in three years. The presentations would be evaluated using checklists and would carry weightage for internal assessment (See Check list II of Internal Assessment). A timetable for the subject with names of the student and the moderator should be scheduled at the beginning of every year.

4. Student Symposium : Recommended as an optional multi disciplinary programme. The evaluation may be similar to that described for subject seminar.

5. Ward Rounds: Ward rounds may be service or teaching rounds.


a. Service Rounds: Postgraduate students and Interns should do ward wounds every day for the care of the patients. Newly admitted patients should be worked up by the PGs and presented to the seniors the following day.

b. Teaching Rounds: Every unit should have ‘grand rounds’ for teaching purpose. A diary should be maintained for day today activities by the students.

Entries of (a) and (b) should be made in the Log Book.

6. Clinico-Pathological Conference: Recommended once a month for all post graduate students. Presentation be done by rotation. If cases are not available due to lack of clinical postmortems, it could be supplemented by published CPCs.

7. Inter Departmental Meetings: Strongly recommended particularly with departments of Pathology and Radio-Diagnosis at least once a week. These meetings should be attended by postgraduate students and relevant entries must be made in the Log Book.

Pathology: A dozen interesting cases may be chosen and presented by postgraduate students and discussed by them as well as the senior staff of Plastic surgery department. The staff of Pathology department would then show the slides and present final diagnosis. In these sessions the advance immuno-histo-chemical techniques, the burgeoning markers other recent developments can be discussed.

Radio-diagnosis: Interesting cases and the imaging modalities should be discussed.

8. Teaching Skills: Postgraduate students must teach under graduate students (Eg. Medical, nursing) by taking demonstrations, bedside clinics, tutorials, lectures etc). Assessment is made using a checklist by surgery faculty as well as students. (See model checklist in Checklist). Record of their participation be kept in Log Book. Training of postgraduate students in Educational Science and Technology is recommended.

9. Continuing Medical Education Programmes (CME): At least 2 state level CME programmes should be attended by each student in 3 years.

10. Conferences: Attending conferences is optional. However it should be encouraged.Rotation and posting in other departments

1. Anatomy for dissection flaps – 3 months, 3 days a week

2. Hand Surgery – 1 month in a reputed center like Stanley Medical College, Chennai etc.

3. Leprosy reconstruction – 10 days, in a reputed center like Scheffeline Leprosy Research & Training Centre, Karigiri (near Vellore) or Central Leprosy Training & Research Institute, Chengalpattu, Tamil Nadu.

4. Burns – 1 month in a reputed center like MBCC, Victoria Hospital, Bangalore or Safdarjung Hospital, New Delhi.

5. Lower limb trauma reconstruction – 2 weeks in a reputed center like Ganga Hospital, Coimbatore.


Monitoring Learning Progress

The learning out comes to be assessed should include: (i) Personal Attitudes, (ii) Acquisition of Knowledge, (iii) Clinical and operative skills, (iv) Teaching skills and (v) Dissertation.

(i) Personal Attitudes. The essential items are: Caring attitudes Initiative Organisational ability Potential to cope with stressful situations and undertake responsibility Trust worthiness and reliability To understand and communicate intelligibly with patients and others To behave in a manner which establishes professional relationships with patients and

colleagues Ability to work in team A critical enquiring approach to the acquisition of knowledge.

The methods used mainly consist of observation. It is appreciated that these items require a degree of subjective assessment by the guide, supervisors and peers.

(ii) Acquisition of Knowledge : The methods used comprise of ‘Log Book’ which records participation in various teachings / learning activities by the students. The number of activities attended and the number in which presentations are made are to be recorded. The logbook should periodically be validated by the supervisors. Some of the activities are listed. The list is not complete. Institutions may include additional activities, if so, desired.

Journal Review Meeting (Journal Club): The ability to do literature search, in depth study, presentation skills, and use of audio-visual aids are to be assessed. The assessment is made by faculty members and peers attending the meeting using a checklist (see Model Checklist –I, Chapter IV).

Seminars / Symposia: The topics should be assigned to the student well in advance to facilitate in depth study. The ability to do literature search, in depth study, presentation skills and use of audio-visual aids are to be assessed using a check list (see Model Checklist – II, Chapter IV)

Clinico-pathological conferences: This should be a multidisciplinary case study of an interesting case to train the candidate to solve diagnostic and therapeutic problems by using an analytical approach. The presenter(s) are to be assessed using a checklist similar to that used for seminar.

Surgical Audit: Periodic morbidity and mortality meeting must be held. Attendance and participation in these must be insisted upon. This may not be included in assessment.

(iii) Clinical and operative skills


Day to day work: Skills in out patient and ward work should be assessed periodically. The assessment should include the candidates’ sincerity and punctuality, analytical ability and communication skills (see Model Checklist III, Chapter IV).

Clinical Meetings: Candidates should periodically present cases to his peers and faculty members. This should be assessed using a check list (see Model Checklist IV, Chapter IV).

Operative skills: The candidate should be given graded responsibility to enable learning by apprenticeship. The performance is assessed by the guide by direct observation. Particulars are recorded by the student in the logbook.

(iv) Teaching skills: Candidates should be encouraged to teach undergraduate medical students and paramedical students, if any. This performance should be based on assessment by the faculty members of the department and from feedback from the undergraduate students.

All assessment must be periodic and by the departmental staff.

(v) Periodic tests: Tests must be based on problem based short essay questions or objective questions for assessment of theoretical knowledge. For the assessment of clinical skills separate clinical examination be held using both long and short cases. The minimum number of tests recommended are three preferably at the end of I and II and three months before completion of the course.

Log Book

The log book is a record of the important activities of the candidate during his training. Internal assessment should be based on the evaluation of the logbook. Collectively, logbooks are a tool for the evaluation of the training programme of the institution by external agencies. The record includes academic activities as well as the presentations and procedures carried out by the candidate.

Format for the log book for the different activities is given in Table 1, 2 and 3 of Annexure 2. Copies may be made and used by the institutions.

Procedure for defaulters: Every department should have a committee to review such situations. The defaulting candidate is counseled by the guide and head of the department. In extreme cases of default the departmental committee may recommend that defaulting candidate be withheld from appearing the examination, if she/he fails to fulfill the requirements in spite of being given adequate chances to set himself or herself right.

b) University examination

Eligibility: The following requirements should be fulfilled by every candidate to become eligible to appear for the final examination.

Attendance, Progress and Conduct: Every student shall attend symposia, seminars, conferences, journal review meetings, grand rounds, CPC, Case presentation, clinics and lectures during each


year as prescribed by the department and not absent himself/herself from work without valid reasons.

Every candidate shall maintain a work diary and Log Book for recording him/her participation in the training programmes conducted by the department such as journal reviews, seminars, etc. Special mention may be made of the presentations by the candidate as well as details of clinical or laboratory procedures, if any conducted by the Head of the department and Head of the Institution and among other things forms the basis for certifying satisfactory progress. The Log Book if demanded be presented in the University clinical or viva-voce examination.

Every candidate should have fulfilled the minimum attendance requirement prescribed by the Medical Council of India and respective University (80% of the training during each academic year of the postgraduate course. Provided further, leave of any kind shall not be counted as part of academic term without prejudice to minimum 80 % attendance of training period every year).

Scheme of Examination

The examination shall consist of:

Written papers (theory), Clinical examination and Viva-voce.

Written Examination (Theory) : Written examination shall consist of four question papers, each of three hours duration. Each paper shall carry 100 marks. Basic medical sciences and recent advances may be asked in any or all the papers.

The distribution of topics in the question papers would be:

Paper I Basic Sciences and General aspects of Plastic & Reconstructive Surgery

Paper II Plastic & Reconstructive Surgery

Paper III Plastic & Reconstructive Surgery

Paper IV Specialty in Plastic & Reconstructive Surgery: Burns, Hand,Esthetic Surgery, Cranio-facial surgery, Maxillo-facial surgery, Micro- vascular surgery.

Note: The distribution of topics shown against the papers are suggestive only.

Clinical Examination: It should aim at examining clinical skills and competence of candidates for undertaking independent work as a specialist. Each candidate should examine at least one long case and two short cases. The total marks for clinical examination shall be 200.

Viva Voce: Viva Voce Examination shall aim at assessing depth of knowledge, logical reasoning, confidence and oral communication skills. The total marks shall be 100.

Mch Plastic & Re-constructive Surgery

Theory Clinical/Practical Viva-voce Grand Total400 200 100 700


RECOMMENDED BOOKS AND JOURNALS

I. Essential Books

1. Grabb & Smith’s Plastic Surgery – 5th Edition. Editors Sherrell J.Aston, Robert W. Beasley & Charles.H.M. Thorne in 1997 by Lippincott – Raven Publishers, New York.

2. Mc Carthy Plastic Surgery Vol. 1 to 8 Editor Joseph G.Mc Carthy, 1990, London. W.B.Saunders

3. Mastery of Plastic & Reconstructive Surgery Vol.1- 3 edited by Mimi Cohen & Robert M. Golwyn, 1944, I Edn. , London Little Brown &Co.

. 4. Fundamentals of Plastic Surgery by Malcolumi W.marks & Charles Marks ,1997,

London. W.B.Saunders Co.

II. Reference Books

i. Flaps

1. Grabb’s Engdopledla of Flab Vol. 1 to 3, 2nd Edition Edited by Berish Strauch, Luiso. Vasconez & Elizabeth J. Hall – Findlay in 1998 by Lippincott – Raven – Publisher in Philadelphia, New York.

2. Mc craw & Arnolds Atlas of Muscle & Muscular Cutanears Flaps Authors David G.Dibbell, G.Partick Maxwell. J.Brien Murphy peterpairolero & Christophpapp in 1986 by John Mc Craw & P.G.Arnold.Publish Hampten press Publishing Company Inc.Narfoll, Virginia.

3. Skin Flaps Edited by William, Brabh & M.Bert Myers in 1975 by little, Brown & Company, Boston.

ii. Burns1. “Current Topics in Burn Care” by Thomas L.Wachtel Virginia Kahn, Hugh A.Frank in

1983 An Aspen Publication Rockville, Maryland, London.

2. Burn Reconstruction by Bruce M.Achauer in 1991 Thieme Medical Publishers Inc. New York.

iii. Breast1. Plastic & Reconstructure Surgery of the Breast, A Surgical Atlas. Contribution by Heinz

Bohmert & Christian J.Gabka in 1997 George Thieme Verlag Stuttgart, New York.2. “Post mastectomy Reconstruction” 2nd Edition Edited by Thomas Dogcart & Luis

O.Vasconez in 1998 Williams & Wilking 428 East, Preston Street, Baltimore USA.3. Noone Plastic & Reconstructure Surgery of Breast edited by R.Barrettnoone in 1991 by

Mosby year book Inc. Philadelphia.


iv. Aesthetic Surgery1. “Aesthetic Facial Plastic Surgery” A multi disciplinary approach by Thomas Romo III &

Arthur L.Millman in 2000 by Thieme Medical Publishers New York.2. “Aesthetic Surgery of Aging face” editor William H.Beeson & E.Gaylen Mc Collough in

1986 by the C,V Mosby Company, St. Louis.3. “The art of Aesthetic Plastic Surgery” edited by John R. lewis, Jr. Vol. I & II in 1986 by

the little, Brown & Company, London.

v. Lasers1. “Lasers in Facial Aesthetic & Reconstructure Surgery”

Edited by Brain S.B. in 1999 Williams & Wilking, a. Waverly Company, London.

2. Leasers in Plastic Surgery & Dermatology Editor: Brace M.Achauer, Victoria M.Vander Kam & Michael W.Berns in 1992 Thieme Medical Publisher Inc. New York, George Thieme Verlag, New York.

vi. Tissue Expansion Reconstructure & Aesthetic Surgery editor Gordon.H.Sasaki in 1998 by Mosby, inc., New York.

vii. Cleft lip & Cleft palate1. Cleft lip & Palate Vol I & II by Samuel Berkowitz, in 1996 by Singular publishing group

inc., London.

2. Cleft palate & Cleft lip: A team approach to clinical and Rehabilitation of the patient by Cooper, Hardeng, Krogman, London.

viii. Nose1. “Atlas of Rhinoplasty, Open & Endonasal approaches”

by Gilbart Aiach in 1996 quality Medical publishing Inc., St. Louis.

2. “Rhinoplasty Sate of the Art” editors Ronald P.Gruber & George C.Peck in 1993 by Mosby year book, Inc., London.

3. “Aesthetic Reconstruction of Nose” author Gary C.Burget & Frederick J.Menick in 1994 by mosby year book inc., London.

ix. Leprosy“The surgical management of Deformities in Leprosy” & other peripheral Neuropathics” editor Noshir H.Antia Carl D.Enna & Behman M.Daver in 1992, Bombay Oxford university press, Delhi, Calcutta, & Madras.

x. Paediatric agePlastic Surgery in infancy & Child hood, edited by J.G.Mustarde 2nd Edition in 1979 by Churchill Liveingstone, London.

xi. Crania facial Surgery

1. “Comprehensive care of cranio – facial deformited” Jeffrey L.Marsh & Michael W.Vannier in 1985 by the C.V.Mosby Company, St.Louis.


2. “Complex Cranio facial problems’ edited by Craig R.Dufresne, Benjamin S.Carson & S.James Tin Reich in 1992 Churchill Livingstone, London.

xii. Hand1. Greens Operative Hand Surgery, 4th edition Vol. I & II

1999 by Churchill Livingston, London.Author David P.Green, Robert N.Hotchiss & William G.Pederson

2. The Hand edited by Raoul Tubiana Vol. I & II in 1981 by W.B.Saunder Company, London.3. Hand Injuries in Atheletes by Strick land & Retting 1992 W.B.Saunder Company, London.

xiii. Nerve1. “Micro reconstruction of Never injuries” by Juliak, Tezis in 1987 W.B.Saunders Company,

London.2. Management of Peripheral Never Problems and edition by Omer Spinner Vanbeek 1998 by

W.B.Saunders Company, Philadelphia.

xiv. “Facial Sea incision, Revesion & Camouflage, by J.Regan Thomas & G.Richard Holt in 1989 C.U.Mosby Company, St.Louis.

xv. Advances in Plastics & Reconstructure Surgery Vol. 11 Mutoz B.Hanal, William G.Lineawer Robert persons Jpohn E.Wood in 1995 Mosby, London.

xvi. Cancer1. Cancer of Face & Mouth by Irana. Mc. Gregor, & Frances M.Mc Greger in

1986 Churchill Livingstone, London.

2. Exusion & Reconstructure of Head & Neck Cancer. Edited by David – S.Soutar & Rammohan Tiwari in 1994 Churchill Livingstone, London.

xviii. Facio Maxillary injury:1. Facial Fractures by S.Antony wolfe for Stephan Baker 1993

Thieme Medical Publisher INC Newyork.2. Facial Fractures by Row & Killy

xix. Genito Urinary1. Hypospadial reconstruction2. Eposordial3. Vaginal A Ge & vagheo plasty

JournalsEssential Reading Desirable1) Plastic and reconstructions surgery 1) Craniofacial Surgery2) Clinics in plastic Surgery 2) Micro vascular surgery3) British journal of Plastic Surgery 3) Journal of Trauma4) Burns 4) Journal of plastic surgery5) Hand


Chapter IVMonitoring Learning Progress

It is essential to monitor the learning progress of each candidate through continuous appraisal and regular assessment. It not only also helps teachers to evaluate students, but also students to evaluate themselves. The monitoring be done by the staff of the department based on participation of students in various teaching / learning activities. It may be structured and assessment be done using checklists that assess various aspects. Checklists are given in Chapter IV.

The learning out comes to be assessed should included: (i) Personal Attitudes, (ii) Acquisition of Knowledge, (iii) Clinical and operative skills, and (iv) Teaching skills.

i) Personal Attitudes. The essential items are: Caring attitudes Initiative Organisational ability Potential to cope with stressful situations and undertake responsibility Trust worthiness and reliability To understand and communicate intelligibly with patients and others To behave in a manner which establishes professional relationships with patients and

colleagues Ability to work in team A critical enquiring approach to the acquisition of knowledge

The methods used mainly consist of observation. It is appreciated that these items require a degree of subjective assessment by the guide, supervisors and peers.

ii) Acquisition of Knowledge : The methods used comprise of `Log Book’ which records participation in various teaching / learning activities by the students. The number of activities attended and the number in which presentations are made are to be recorded. The log book should periodically be validated by the supervisors. Some of the activities are listed. The list is not complete. Institutions may include additional activities, if so, desired.

Journal Review Meeting (Journal Club): The ability to do literature search, in depth study, presentation skills, and use of audio- visual aids are to be assessed. The assessment is made by faculty members and peers attending the meeting using a checklist (see Model Checklist – I, Chapter IV)

Seminars / Symposia: The topics should be assigned to the student well in advance to facilitate in depth study. The ability to do literature search, in depth study, presentation skills and use of audio- visual aids are to be assessed using a checklist (see Model Checklist-II, Chapter IV)

Clinico-pathological conferences : This should be a multidisciplinary case study of an interesting case to train the candidate to solve diagnostic and therapeutic problems by using an analytical approach. The presenter(s) are to be assessed using a check list similar to that used for seminar.

Medical Audit: Periodic morbidity and mortality meeting be held. Attendance and participation in these must be insisted upon. This may not be included in assessment.

iii) Clinical skills


Day to Day work : Skills in outpatient and ward work should be assessed periodically. The assessment should include the candidates’ sincerity and punctuality, analytical ability and communication skills (see Model Checklist III, Chapter IV).

Clinical meetings : Candidates should periodically present cases to his peers and faculty members. This should be assessed using a check list (see Model checklist IV, Chapter IV).

Clinical and Procedural skills : The candidate should be given graded responsibility to enable learning by apprenticeship. The performance is assessed by the guide by direct observation. Particulars are recorded by the student in the log book. (Table No.3, Chapter IV)

iv) Teaching skills : Candidates should be encouraged to teach undergraduate medical students and paramedical students, if any. This performance should be based on assessment by the faculty members of the department and from feedback from the undergraduate students (See Model checklist V, Chapter IV)

vi) Periodic tests: The departments may conduct three tests, two of them be annual tests, one at the end of first year and the other in the second year. The third test may be held three months before the final examination. The tests may include written papers, practicals / clinicals and viva voce.

vii) Work diary / Log Book- Every candidate shall maintain a work diary and record his/her participation in the training programmes conducted by the department such as journal reviews, seminars, etc. Special mention may be made of the presentations by the candidate as well as details of clinical or laboratory procedures, if any conducted by the candidate.

viii) Records: Records, log books and marks obtained in tests will be maintained by the Head of the Department and will be made available to the University or MCI.

Log book

The log book is a record of the important activities of the candidates during his training, Internal assessment should be based on the evaluation of the log book. Collectively, log books are a tool for the evaluation of the training programme of the institution by external agencies. The record includes academic activities as well as the presentations and procedures carried out by the candidate.

Format for the logbook for the different activities is given in Tables 1,2 and 3 of Chapter IV. Copies may be made and used by the institutions.

Procedure for defaulters: Every department should have a committee to review such situations. The defaulting candidate is counseled by the guide and head of the department. In extreme cases of default the departmental committee may recommend that defaulting candidate be withheld from appearing the examination, if she/he fails to fulfill the requirements in spite of being given adequate chances to set himself or herself right.


CHAPTER IV (Contd.)

Format of Model Check Lists

Check List -1. MODEL CHECK-LIST FOR EVALUATION OF JOURNAL REVIEW PRESENTATIONS

Name of the Student: Name of the Faculty/Observer: Date:

Sl. No.

Items for observation during presentation Poor

0

Below Average

1

Average

2

Good

3

Very Good

4

1. Article chosen was

2. Extent of understanding of scope & objectives of the paper by the candidate

3. Whether cross references have been consulted

4. Whether other relevant publications consulted

5. Ability to respond to questions on the paper / subject

6. Audio-Visual aids used

7. Ability to defend the paper

8. Clarity of presentation

9. Any other observation

Total Score


Check List - 2. MODEL CHECK-LIST FOR EVALUATION OF SEMINAR PRESENTATIONS

Name of the Student: Name of the Faculty/Observer: Date:

Sl. No.

Items for observation during presentation Poor

0

Below Average

1

Average

2

Good

3

Very Good

41.

Whether other relevant publications consulted

2. Whether cross references have been consulted

3. Completeness of Preparation

4. Clarity of Presentation

5.Understanding of subject

6. Ability to answer questions

7. Time scheduling

8. Appropriate use of Audio-Visual aids

9. Overall Performance

10.Any other observation

Total Score


Check List - 3

MODEL CHECK LIST FOR EVALUATION OF CLINICAL WORK IN WARD / OPD

(To be completed once a month by respective Unit Heads including posting in other departments)

Name of the Student: Name of the Unit Head: Date:

Sl. No.

Points to be considered: Poor

0

Below Average

1

Average

2

Good

3

Very Good

4

1. Regularity of attendance

2. Punctuality

3. Interaction with colleagues and supportive staff

4. Maintenance of case records

5.Presentation of cases during rounds

6. Investigations work up

7. Beside manners

8. Rapport with patients

9. Counseling patient's relatives for blood donation or PM

10. Over all quality of Ward work

Total Score


Check List – 4 EVALUATION FORM FOR CLINICAL PRESENTATION

Name of the Student: Name of the Faculty: Date:Sl. No.

Points to be considered Poor

0

Below Average

1

Average

2

AboveAverage

3

Very Good

4

1. Completeness of history

2. Whether all relevant points elicited

3. Clarity of Presentation

4. Logical order

5. Mentioned all positive and negative points of importance

6. Accuracy of general physical examination

7. Whether all physical signs elicited correctly

8. Whether any major signs missed or misinterpreted

9.Diagnosis:Whether it follows follows logically from history and findings

10

Investigations required Complete list Relevant order

Interpretation of investigations

11.Ability to react to questioningWhether it follows logically from history and findings

12. Ability to defend diagnosis

13. Ability to justify differential diagnosis

14. Others

Grand Total


Check List - 5

MODEL CHECK LIST FOR EVALUATION OF TEACHING SKILL PRACTICE

Sl. No. Strong Point Weak Point

1. Communication of the purpose of the talk

2. Evokes audience interest in the subject

3. The introduction

4. The sequence of ideas

5. The use of practical examples and/or illustrations

6. Speaking style (enjoyable, monotonous, etc., specify)

7. Attempts audience participation

8. Summary of the main points at the end

9. Asks questions

10. Answers questions asked by the audience

11. Rapport of speaker with his audience

12. Effectiveness of the talk

13. Uses AV aids appropriately


LOG BOOK

Table 1 : Academic activities attended

Name: Admission Year:

College:

DateType of Activity

Specify Seminar, Journal Club, Presentation, UG teaching

Particulars


LOG BOOK

Table 2 : Academic presentations made by the student


College:

Date TopicType of Presentation

Specify Seminar, Journal Club, Presentation, UG teaching etc.


LOG BOOK

Table 3 : Diagnostic and Operative procedures performed


College:

Date Name ID No. Procedure CategoryO, A, PA, PI*

* Key: O - Washed up and observedA - Assisted a more senior SurgeonPA - Performed procedure under the direct supervision of a senior surgeonPI - performed independently


Model Overall Assessment Sheet

Name of the College: Academic Year:

Check List No Particulars

Name of Student and Mean Score

A B C D E F G H I J

1 Journal Review Presentations

II Seminars

III Clinical work in wards

IV Clinical presentation

V Teaching skill practice

Total Score

Note: Use separate sheet for each year.


Chapter V

Medical EthicsSensitisation and Practice

IntroductionThere is now a shift from the traditional individual patient, doctor relationship, and

medical care. With the advances in science and technology and the needs of patient, their families and the community, there is an increased concern with the health of society. There is a shift to greater accountability to the society. Doctors and health professionals are confronted with many ethical problems. It is, therefore necessary to be prepared to deal with these problems. To accomplish the Goal (i), General Objective (ii) stated in Chapter II (pages 2.1 to 2.3), and develop human values it is urged that ethical sensitisation be achieved by lectures or discussion on ethical issues, clinical case discussion of cases with an important ethical component and by including ethical aspects in discussion in all case presentation, bedside rounds and academic postgraduate programmes.

Course Contents 1. Introduction to Medical Ethics

What is EthicsWhat are values and normsRelationship between being ethical and human fulfillmentHow to form a value system in one’s personal and professional lifeHeteronomous Ethics and Autonomous EthicsFreedom and personal Responsibility

2. Definition of Medical EthicsDifference between medical ethics and bio-ethicsMajor Principles of Medical Ethics

Beneficence = fraternityJustice = equalitySelf determination (autonomy) = liberty

3. Perspective of Medical EthicsThe Hippocratic oathThe Declaration of HelsinkiThe WHO Declaration of GenevaInternational code of Medical Ethics (1993)Medical Council of India Code of Ethics

4. Ethics of the IndividualThe patient as a personThe Right to be respectedTruth and ConfidentialityThe autonomy of decisionThe concept of disease, health and healingThe Right to health Ethics of Behaviour modificationThe Physician – Patient relationshipOrgan donation


5. The Ethics of Human lifeWhat is human lifeCriteria for distinguishing the human and the non-humanReasons for respecting human lifeThe beginning of human lifeConception, contraceptionAbortionPrenatal sex-determinationIn vitro fertilization (IVF), Artificial Insemination by Husband (AIH)Artificial Insemination by Donor (AID),Surrogate motherhood, Semen Intrafallopian Transfer (SIFT),Gamete Intrafallopian Transfer (GIFT), Zygote Intrafallopian Transfer (ZIFT),Genetic Engineering

6. The Family and Society in Medical EthicsThe Ethics of human sexualityFamily Planning perspectivesProlongation of lifeAdvanced life directives – The Living WillEuthanasiaCancer and Terminal Care

7. Profession EthicsCode of conductContract and confidentialityCharging of fees, Fee-splittingPrescription of drugsOver-investigating the patientLow – Cost drugs, vitamins and tonicsAllocation of resources in health caresMalpractice and Negligence

8. Research EthicsAnimal and experimental research / humannessHuman experimentationHuman volunteer research – Informed ConsentDrug trials

9. Ethical workshop of casesGathering all scientific factorsGathering all human factorsGathering all value factorsIdentifying areas of value – conflict, Setting of priorities,Working out criteria towards decisions

Recommended ReadingFrancis C.M., Medical Ethics, 1 Ed, 1993, Jaypee Brothers, New Delhi, p 189, Rs. 60/-


Rajiv Gandhi University of Health Sciences, Karnataka4th T Block, Jayanagar, Bangalore - 560 041

No. UA/ORD-06/1999-2000 01.01.2000

NOTIFICATION

Sub: Revised Ordinances pertaining to Post Graduate Degree, Diploma and Super Speciality Courses in Medicine

Ref: Minutes of the 16th syndicate meeting held on 16.11.1999.

In exercise of the powers conferred under Sec. 35(2) of the RGUHS Act, the Syndicate at its meeting held on 16.11.1999 has been pleased to approve the Revised Ordinances pertaining to Post Graduate Degree, Diploma and Super Speciality Courses in Medicine as given in schedule here to annexed.

The Revised Ordinances as above shall come into force immediately and is applicable for University examination of March 2000 and onwards.

By order, Sd/REGISTRAR

To

3. The Principals of all Medical Colleges affiliated to RGUHS4. The Members of the Syndicate/Senate/Academic Council.


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